On Monday afternoon, 10th September 2001, I saw *********** ********** for an examination and evaluation. The good news for me is that the retina is OK. As I told him, I am not looking for problems and wish everything was all right, but he noted that the cataracts were most definitely present and corrective surgery indicated.

I was pleased to note that this could be available as early as October [2001] for the first eye to be done. He explained the parameters and prognosis to me for this condition as regards its treatement and the future for a "window" projecting likely development if untreated. If I existed currently in normal circumstances, I would have opted for surgery at the earliest possible time. However, that is not the case which is a "causitive" issue and impact on me from other sources which are basically irrelevant to your medical treatment although there is a peripheral concern as regards to continuing impact on the eyes and with regard to NHS administration.

With respect to the letters I have been sending to ******** ********* as part of the distribution list, there were daily dairy/logs of the activity which impacted my life during July and August 2001. The only relevant point from your medical perspective and that of ********* ********** as I explained was and is the chronic sleep deprivation to which I have been subjected for the past three plus years.

This is an unbelievable situation at present, and I felt it necessary to communicate in such a way as to describe its impact and seek to have it stopped for many reasons including the personal injuries which it is doing to me. I consider the onset of cataracts to be a direct result of this activity as has already been explained, but again that is another issue and not your concern.

However, the impact of the chronic sleep deprivation is critically important, and for this reason I declined the immediate surgery option until this matter can be addressed properly and stopped. The reasons I cited are that the physiology of the body is basically destroyed by externally produced chronic sleep deprivation that I have been subjected to on a daily basis for the past three plus years.

I told ********* ************* that in early June 1998 I had biopsy surgery for two biopsies one of which was positive. At that time this experience impacting my life was starting, and for all practical purposes I got virtually no sleep for five days. These minor wounds were still bleeding internally and not healing at all after five days. By contrast, 22 years ago when I had the cancer surgery which was a four-hour, complex operation, my oncological surgeon at that time removed the sutures on a Friday after Monday's surgery from about a 12 inch scar and his plastic surgery. There were no such problems.

From my personal experience I know how to take care of myself and do so. Sleep, rest and a properly undisturbed environment is important so that one can let the body heal itself. I learned from this more recent experience that sleep is critically important. Since then, I have noted an article in the "Lancet" which explains why based on some excellent research. For both these reasons of personal experience and the research I have noted, I declined to undertake the surgery at present until I *know* that I can rest and sleep as needed without constant external disturbances as described in my correspondence to ********** ************ this past summer. At present I cannot do that.

I would like to quote from the "Lancet" article as I think it is terribly important in this regard. It begins with the statement "Sleep debt is believed to have no adverse effect on health." It concludes with the statement interpreting the research results that "Sleep debt has a harmful impact on carbohydrate metabolism and endocrine function."

The article is "Early Report: Impact of sleep debt on metabolic and endocrine function" in the "Lancet," Vol 354, 23rd October 1999, p 1435. Its authors are Karine Speigel, Rachel Leproult and Eve Van Cauter. This is a fascinating study with its comments which I highly recommend. I would like to quote from it as regards to another introductory point among several interesting ones and its conclusion perhaps for my own benefit more than anything. Its points are to be well heeded I believe as regards to maintaining well-being and health largely due to misconceptions and "popular" beliefs.

"No study has assessed the potential health impact of chronic sleep debt. Despite well documented modulation by sleep of metabolic and endocrine regulation, immune function, and cardiovascular variables, the consensus is that sleep is for the brain, not for the rest of the body, and that sleep debt has little or no effect on peripheral function." (p 1435)

"Discussion"

"Less than 1 week of sleep curtailment in healthy young people is associated with striking alterations in metablic and endocrine function. Therefore, although the primary function of sleep may be cerebral restoration, sleep debt also has consequences for peripheral function that, if maintained chronically, could have long-term adverse effects on health. Decreased carbohydrate tolerance and increased sympathetic tone are well-recognised risk factors for the development of insulin resistance, obesity, and hypertension. Raised cortisol concentrations in the evening are thought to reflect an impairment of the negative-feedback control of the hypothalamo-pituitary-adrenal axis and to be involved in age-related insulin resistance and memory impairments. The metabolic and endocrine alterations seen during the sleep-debt condition therefore mimic some of the hallmarks of ageing, which suggests that chronic sleep loss could increase the severity of age-related pathologies, such as diabetes and hypertension." (1438)

"Our data further indentified pathways by which the impact of sleep debt on the central nervous system could be translated to the periphery. Increases in the sympathetic compared with the parasympathetic tone, which we interpret as the most robably cause of decreased Beta-cell responsiveness in the sleep debt condition, may negatively effect cardiac function, regulation of blood pressure, and kidney function. A decrease in non-insulin dependent glucose uptake results in increased exposure of peripheral tissues to higher glucose oncentrations, which, under chronic conditions, will probably facilitate the development of insulin resistance in predisposed individuals. The slower decrease of cortisol concentrations was consistent with altered hippocampal mechanisms that control negative control feedback regulation of the hypothalamo-pituitary-adrenal axis. Metabolic and cognitive function could therefore be adversely affected under chronic conditions." (1439)

"Irrespective of the underlying mechanisms, when compared with sleep-recovery condition, sleep debt, which is experienced by a substantial proportion of people in more developed countries, is clearly associated with metabolic and endocrine alterations that may have physiopathological consequences in the long erm." (p 1439)

From my layman's assessment, this means no surgery until I can stop the externally generated chronic sleep debt problem. If I am left alone as I was last night, I just sleep right hrough. I did so for five hours last night before being disturbed by excessive external disruptions.

I want to point out that I have been having a tremendous problem with misdiagnosis of this chronic sleep deprivation problem from a "remote" location without any personal medical interaction or direct evaluation. Although this does not affect you as regards my eye sight pathologies, there are statements in this research about physiological impact from chronic sleep deprivation which can be misdiagnosed. These are the negative hippocampus impact on the brain and resulting advserse cognitive impact "under chronic conditions" among others which I am sure are similar but not noted symptoms in this research.

I point this out in order to state that I will now stop sending *********** ************** the daily diary/log because this point has been well made for your purposes. You need to understand why I had to postpone the surgery until the chronic sleep deprivation is stopped. It took the detail and the overview both for me to properly communicate what is happening in this incredible (literally unbelievable) situation. My problem here rests with other health professionals.

I also want to point out the extraordinary difference in facilities and patient care that I found in my visit Monday. It is not that it was not excellent as I have noted in past complimentary correspondence in December 1998 when my experience that year from the treatment I received in the motility clinic was outstanding, but that the renovation was very nice and the apparent new equipment from the layman's point of view was nothing short of spectacular.

*********** *********** had to examine my eyes for a prescription and did so literally in seconds with the equipment there. That makes all the difference in patient care and time spent on critical items. He then compared it with my 22nd March 2001 optometrist's record that I had, and, fortunately for me, the results were similar. The overall procedure was most efficient and well set up. I was out by 4:00 pm after my 3:00 pm appointment in a clinic environment when I had been nicely told that there might be a delay due to shortage of staff. I am quite patient and was prepared to wait, but everyone was being cared for promptly. I must say that it appears that improvements are becoming evident.

Please share this with ************ ************ if you would please, and thank you very much.

Yours sincerely

Gary D Chance

Copyright 1996 - 2001 by Gary D Chance

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